Gavin, Mark R
Gavin, Mark R is an sole proprietor health care provider with primary practice located at 420 Delaware St Se Mmc 480, Minneapolis MN 55455-0341. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Gavin, Mark R can be contacted via phone (612) 624-0123.Contact Information
Primary practice address
420 Delaware St Se Mmc 480
Minneapolis MN 55455-0341
Phone: (612) 624-0123
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 46726 | Minnesota |
Profile Details
| NPI number | 1811969785 |
|---|---|
| LBN Legal business name | Gavin, Mark R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 6th, 2006 |
| Last updated | Oct 12th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811969785 | NPPES |
| Minnesota | MEDICAID | 110116100 |
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